Often people with an atrial septal defect live for many years before a pathology is detected. For parents, this becomes a real shock, as it is a cardiac pathology.
This disease is characterized by the presence of an abnormal connection between the chambers of the heart muscle. Atrial septal defects, whose ICD-10 code is Q21.1, differ in the location of the opening. In addition, they can be classified according to the size of the violation.
For the diagnosis and subsequent treatment of great importance is the number of defects, as well as the peculiarity of the course of the disease.
Disease feature
Atrial septal defect (ICD code Q21.1) refers to congenital diseases and is caused by an increased degree of risk, especially in the absence of timely comprehensive treatment. As a result of this, life expectancy is generally 45-50 years. In this case, with an atrial septal defect, there is a high risk of a thrombus, which disrupts the functioning of the cardiac system and can provoke such dangerous pathologies as a stroke or heart attack.
In women, such a violation is much more common than in men. The atrial septal defect (ICD-10 - Q21.1) has its own specific manifestations. A newborn baby may not have visible abnormalities, however, the doctor should be alert to the bluish tint of the skin. This is because in a newborn child, arterial and venous blood does not mix and there is no increase in the load on the heart muscle.
First appearances may be noticeable at the age of 3-5 months. During this period, shortness of breath appears, the state of health sharply worsens, the child becomes inactive and lethargic. In this case, be sure to consult a doctor.
In an adult, pathology is manifested in the fact that he cannot perform physical work, since he immediately experiences shortness of breath, his health worsens significantly, and severe arrhythmia also appears. The heart rate rises and oxygen supply to the tissues is impaired.
Despite the fact that the disease is well studied, the reasons for its occurrence have not yet been established. There are a number of factors that can be attributed to risk indicators.
Main forms
For greater convenience, understanding the patient’s well-being in a similar pathological condition, 3 types of atrial septal defect are distinguished, in particular, such as:
- open oval window;
- primary defect;
- secondary defect.
An open oval window is formed during the period of the fetus in the womb. A window is required for gas exchange at a time when the lungs have not yet begun to function. Then it gradually closes with a valve that grows tightly to the intracardiac septum.
However, in some cases, the valve does not grow to the septum, or its size exactly matches the size of the oval window, and then in the case of emotional or physical stress, the valve moves away and blood flows into the right ventricle from the left.
The primary defect is characterized by the fact that the valves separating the atria from the ventricles are changed, so they cannot close the existing holes tightly. A secondary atrial septal defect in a newborn is characterized by the anomalies of the superior vena cava.
Causes of occurrence
Atrial septal defect refers to congenital malformations and can develop on its own or together with various other disorders, in particular, such as:
- mitral valve insufficiency;
- abnormal introduction of pulmonary veins;
- defeat of the interventricular septum.
It is impossible to say exactly what caused the violation, but you can definitely say that it develops during the development of the fetus, when the fetal organs are just laid and formed. According to experts, an atrial septal defect develops for reasons such as:
- rubella in early pregnancy;
- smoking and alcohol abuse;
- taking certain medications;
- gene mutations;
- hereditary predisposition.
It is important to recognize the main signs of a violation in a timely manner and consult a doctor for diagnosis and treatment.
Main symptoms
Among the main signs of an atrial septal defect can be called the occurrence of dyspnea, which appears even with slight physical exertion, as well as with emotional overstrain. In addition, there is an excessive blanching of the skin and the acquisition of a bluish tint.
Edema of the face and limbs should also be alerted, since they act as one of the manifestations of such a disease. For children, a characteristic sign will also be reluctance to play outdoor games for a long time, a prolonged course of bronchitis, followed by its transition to pneumonia. The child refuses to feed, he may lack oxygen even with the slightest physical activity.
Preschool children who have been diagnosed with a congenital atrial septal defect are poorly developed, they have pale skin, they have poor appetite. In a child, a pulse is very easily felt in the sternum, and significant heart murmurs are observed all the time. For adults, frequent and prolonged bronchitis and pneumonia are characteristic.
Diagnostics
If the first signs of heart disease and atrial septal defect occur, you need to undergo a comprehensive examination by a cardiologist. To make a diagnosis, a comprehensive examination is performed to determine the existing pathologies in the development of the cardiovascular system and prescribe the appropriate treatment. The most informative diagnostic measures include:
- chest x-ray;
- echocardiography;
- cardiogram;
- insertion of a catheter into the heart;
- angiocardiography.
Using x-rays, you can determine the change in the size of the heart muscle and its individual parts, which can indicate the presence of violations, as well as stagnation of blood in large veins. Angiography allows you to determine the presence or absence of holes in the interatrial septum. For this, a dye is injected into the blood of one of the atria, which provides the appearance of the movement of blood in the heart.
All these diagnostic methods are applied to school children and adults, and in newborns, such a pathology for a long time does not reveal itself at all. A similar violation can be detected after ultrasound of the heart.
For newborns, diagnostic methods such as listening to the heart are used. With a stethoscope, the doctor can detect the presence of extraneous noise, which may be when passing narrowed valves in the heart septum. Electrocardiography and ultrasound also make it possible to determine the presence of heart muscle size and stagnation of blood in large vessels. If there are indications for urgent surgical intervention, cardiac catheterization is indicated.
After diagnosing defects of the atrial and interventricular septum, appropriate treatment is prescribed, since the timeliness of the measures taken makes it possible not only to improve the patient's quality of life, but also to extend the maximum period of life.
Treatment features
Correct and timely treatment of a primary or secondary atrial septal defect can prevent the occurrence of undesirable consequences, and in the event of complications, stop their subsequent progression. The only exception is the situation when the disease is severely neglected and irreversible changes in the lungs have occurred; surgery cannot be performed.
With a defect in the atrial septum, German specialists say that the sooner surgery is performed, the lower risks for the child will be in the future. However, first you need to conduct a comprehensive diagnosis and, according to the results obtained, make a decision regarding the period and methods of the operation.
Medication does not completely eliminate the defect, however, drug therapy is also used separately and in combination with surgical techniques. Medications make it possible to reduce the risk of inflammation and thrombosis, as well as normalize heart rate. Basically prescribed antibacterial, hemorrhaging, diuretic drugs.
Therapeutic treatment
Now there are some of the most effective approaches to treating the atrial septal defect. All of them are aimed at reducing the load on the heart muscle. If this violation is found in the newborn, the doctor prescribes constant monitoring of the condition of the child, since small holes in the heart can independently overgrow after a certain age. If there are several holes or a heart defect and an atrial septal defect are combined, then an operation is prescribed.
The therapeutic treatment is prescribed for small openings in the heart. The calculation is carried out taking into account the possibility of their independent overgrowing, however, this technique is rarely used. Most sick children recover between the ages of 18-22 months. However, regular visits to the doctor and the conduct of appropriate examinations are required.
Drug treatment
No drug can cure a congenital heart disease - a defect in the atrial septum, and also lead to the healing of openings in the heart. However, their use allows you to normalize the heart rhythm, stabilize the well-being of the patient. In addition, this contributes to a more rapid elimination of an existing septal defect in the heart.
The medications that are used to treat an existing defect should include such as:
- beta blockers;
- blood clotting agents;
- "Digoxin".
In some cases, when diagnosing CHD - an atrial septal defect - surgery is prescribed.
Operation
If there is a defect in the atrial septum, the operation is performed only if there is such evidence as:
- heart failure development;
- frequent colds;
- lag in physical development;
- increased pulmonary vascular resistance.
Two main types of surgical intervention are used, namely with the use of a cardiopulmonary bypass and the endovascular method. In the first case, the doctor openly conducts a neat incision in the wall of the right atrium. Estimates the size of the lesion and selects the most optimal way to eliminate the problem. After this, the existing defect is sutured if its size does not exceed 10-12 mm, or plastic is carried out using a special patch.
Leading cardiological centers mainly prefer the endovascular method of surgical intervention. It does not involve the opening of the chest, which means it is safer for the patient. A big plus is the minimum duration of the operation. The essence of surgical intervention is that the affected area is closed using an occluder. This is a special device that is inserted through a catheter that penetrates through a puncture vein on the thigh. With this method of surgical intervention, there is no need to stay for a long time in the intensive care unit.
After the operation, the rehabilitation period is of great importance. Doctors recommend conducting it at a cardiology center. If the surgical intervention was performed using an occluder, then you need to conduct an echocardiography once a month so that you can monitor the position of the microdevices used.
What is the danger of violation
After treatment in the presence of a defect, certain complications may occur. When performing a surgical intervention, an urgent need to call a doctor in case of redness of the joints and raising the temperature above 38 degrees. It is also necessary to conduct an examination for changes in heart rate and the occurrence of attacks of tachycardia, as well as insufficiency of the right heart.
In the absence of treatment, there may be a blood clot, which can lead to a heart attack or stroke, and a fatal outcome is also possible. That is why timely diagnosis and treatment are mandatory in the presence of pathology. Properly conducted therapy can significantly extend the patient's life and improve its quality.
An atrial septal defect can be complicated by pathologies such as:
- arrhythmia;
- infectious endocarditis;
- pulmonary hypertension;
- rheumatism;
- bacterial pneumonia;
- acute heart failure.
If you do not treat the disease in a timely manner, then a person with a congenital malady survives only up to 40-50 years. If there is a large aneurysm of the septum, there is a significant risk of its rupture, which can lead to the death of the child.
Preventive actions
As a prevention of the formation of a disorder, it is necessary to exclude the consumption of alcohol during pregnancy, as well as certain medications that can provoke a malfunction of the baby's cardiovascular system.
In order for a child to be born healthy, the expectant mother must lead a healthy lifestyle, and also avoid emotional overstrain. In addition, a pregnant woman needs:
- eat properly and balanced;
- regularly undergo examination in consultation and take all the required tests;
- give enough time to rest;
- avoid radioactive and toxic effects;
- do not take medicine without a doctor's prescription;
- timely vaccination against rubella.
It is very important to try to exclude the effect of external negative factors on the pregnant woman.
Prognosis after treatment
With a timely examination and at the very beginning of the treatment, the prognosis is as favorable as possible. The life expectancy of the patient is significantly increased, and the risk of relapse becomes minimal.
With proper timely treatment, 5-year survival is approximately 85-92%. The postoperative death at closure of an existing hole in childhood is almost 0 percent, and during treatment in adulthood, the risk of death is significantly increased.
Correctly carried out rehabilitation after treatment makes it possible to further reduce the risk and restore the patient's well-being. Some patients survive to 70 years, but after 50 years become disabled. Spontaneous spontaneous closure of a defect in children aged 5-6 years occurs in 3-5% of cases.